Comparison between TG-51 and TRS-398: Electron Contamination Effect on Photon Beam Quality Specification.

Comparison between TG-51 and TRS-398: Electron Contamination Effect on Photon Beam Quality Specification. Antonio Lopez Medina, Antonio Teijeiro, Daniela Medal, Francisco Salvador, Julio Vazquez, Manuel Salgado, María C. Carrión Department of Medical Physics, Instituto Galego de Medicina Técnica. Hospital do Meixoeiro. 3600. Vigo. SPAIN Department of Applied Physics. Faculty of Sciences. University of Granada. 18071. Granada. SPAIN E-mail address: antonio.lopez.medina@sergas.es 0. Abstract Two dosimetry protocols based on absorbed dose to water have recently been implemented: TG-51 and TRS-398. These protocols use different beam quality indices: %dd(10) x and TPR 0,10. The effect of electron contamination in measurements of %dd(10) x has been proposed as a disadvantage of the TG-51. For actual measurements of %dd(10) x on five clinical beams (Primus 6 18 MV, SL-75/5 6 MV, SL-18 6 15 MV) a purging was employed to remove the electron contamination. Also, %dd(10) x was measured in the different ways described in TG-51 for high-energy beams: with a lead foil at 50 cm from the phantom surface, at 30 cm, and for open beam. Moreover, TPR 0,10 was determined. Considering both protocols, S w,air and k Q were calculated in order to compare the results with the experimental data. Significant differences (0.3% for k Q ) were only found for the two highenergy beams, but when the electron contamination is underestimated by TG-51, the difference in k Q is lower. Differences in the other cases and variations were less than 0.1%. 1. Introduction In recent years, two new dosimetry protocols based on absorbed-dose-to-water have been implemented: TG-51 of the AAPM [1]; and An International Code of Practice for Dosimetry based on Standards of Absorbed Dose to Water (TRS-398) of the IAEA []. Both propose procedures in which dose to water in the user beam are derived from an absorbed dose to water calibration factor, in N D, w, Q a reference beam quality Q0. Previous protocols (TG-1 [3], TRS-381 [4], TRS-77 [5]) were based on air kerma standard. A beam quality dependence correction factor, denoted as, is used to fit to the user beam quality, Q. Direct measurements of at the same quality as the user beam are not feasible in most standard laboratories, and therefore theoretical values [6][7][8] are commonly used. Each protocol uses a different beam-quality index: TPR0,10 in TRS-398 and %dd(10) x of TG-51. The effect of electron contamination in measurements of %dd(10) x has been proposed as a disadvantage of TG-51. On the other hand, the benefits of using %dd(10) x Rogers [8], Li and Rogers [9], Kosunen and Rogers [10] have remarked the linearity of the relation between stopping power ratio and %dd(10) x even for non clinical beams, such as photon beams of some standards laboratories. The main argument against the use of %dd(10) x expressed by Andreo [11][1] is that electron contamination is calculated for general machines, considering some clinical spectra, but not for the actual machine where measurements are being performed. Electron contamination is machinedependent, but has should not affect the beam-quality correction factor. The use of clinical beams for direct measurements in primary standards laboratories, has been proposed by this author and k Q,Q0 TPR0,10 as the beam quality index. k Q,Q0 k Q,Q0 0 1

A purging has been performed to remove the electron contamination. This electron contamination can be determined for each beam, and measured %dd(10) x can be compared with %dd(10) x calculated from %dd(10) Pb or %dd(10) in the different ways described in TG-51. On the other hand, TPR 0,10 has been determined as another beam quality index. Considering both protocols and related literature, S w,air and k Q have been calculated in order to compare results with experimental data.. Materials and methods The measurements were performed in five photon beams in a Siemens Primus and two Elekta linacs (SL-18 and a SL75/5). The five clinical beams are: 6 and 18 MV by Primus, 6 and 15 MV by SL-18, and 6MV by SL-75/5 installed in the Radiotherapy Department of the Hospital do Meixoeiro..1 Purging design TG-51 calculates %dd(10) x from depth dose profiles of a filtered beam by a lead foil. This foil must be placed at 50 ± 5 cm from the phantom surface. For measurements of %dd(10) x in five clinical beams a purging has been performed. A U-shaped iron structure was constructed in order to confine the ic field. Each of Nd-Fe-B was placed on one arm of the U-shaped structure. The ic field measured in the centre of the beam is 0. T and a gap of 10 cm (maximum field size available: 13 1 cm depending on the machine) is obtained. Magnetic field in the centre of the is similar to previous measurements with purging s [13][14][15][16].. Beam quality specification Central axis depth dose profiles were measured with a Wellhöfer IC-10 cylindrical ionization chamber in a computerized Scanditronix-Wellhöfer WP700 water tank. Field size at beam axis was set to 10 x 10 cm, and SSD was fixed at 100 cm. For low energy measurements, only two depth dose profiles were obtained for each beam: with and in open beam. For the Primus 18 MV beam eleven depth dose profiles were measured: in open beam, with the, with a 1 mm thick lead foil at 51, 50, 49, 45. and 30 cm from the phantom surface, and with and the lead foil at 51, 50, 49, 45.. The last set of measurements with the and the lead foil was performed to determine any additional beam-hardening effect. Also, variation with lead foil positioning was measured. For the SL-18 15 MV beam five depth dose profiles were measured: in open beam, with, with lead foil at 46. and 9. cm from the phantom surface, and with and lead foil at 46. cm. %dd(10) x was determined directly with depth-dose curves measured using the and estimated with TG-51 formulae for open beam and measurements with lead foil. In the case of open beam and low energies, TG-51 estimates %dd(10) x = %dd(10), but for higher energies ( 75% < %dd(10) < 89% ) uses the following expression: %dd(10) x = 1.67 %dd(10) 0 (1) which reduces [10] the uncertainty in S w,air to 0.% (0.4% with no correction). When the lead foil is positioned at 50 ± 5 cm from the phantom surface and %dd(10) Pb 73%, the correcting expression is: %dd(10) x = (0.8905 + 0.00150 %dd(10) Pb ) %dd(10) Pb () Finally, if lead foil is placed at 30 ± 1 cm from the phantom surface and %dd(10) Pb 71%:

%dd(10) x = (0.8116 + 0.0064 %dd(10) Pb ) %dd(10) Pb (3) These last two corrections, have a maximum uncertainty [17] of 0.5%. Thus if a rectangular probability density is considered, the type B uncertainty due to these fits can be set to 0.3%. According to Rogers and Yang [18], the relationship between %dd(10) x and S w,air is: S w,air = 1.75 0.0031 %dd(10) x. (4) The associated standard deviation to this fit is 0.0011. TPR 0,10 was measured in the five beams with the Wellhöfer IC-10 chamber using a Scanditronix- Wellhöfer WP700 3D scanning system, but varying the water level instead of moving the chamber. Measurements were made as described in Andreo & Brahme [19], while TPR 0,10 in SL-18 was performed with SSD = 100 cm. For calculation of stopping power ratio, the next cubic fit was used [0]: S w,air = 1.3614 1.963 TPR 0,10 +.530 (TPR 0,10 ) 1.6896 (TPR 0,10 ) 3 (5) This expression fits the data better than 0.15%, and type B standard uncertainty of 0.09% was used. Both new protocols are based on absorbed-dose-to-water, and S w,air was used for calculations of k Q, until direct measurements are available. S w,air and p wall are the main source of uncertainty in k Q calculations. Anyway, tabulated values of k Q were compared from both protocols for each beam. 3. Results 3.1 Electron contamination Depth dose measurements were normalized at 10 cm depth. As a result of measurements with and without, depth ionization variation doubt to electron contamination has been measured for a field size of 10 x 10 cm at SSD = SAD = 100 cm. For the three low energy beams, electron contamination from treatment head was determined and is shown in figure 1. Estimation of electron contamination in the maximum can be obtained from equations 1 3. Comparisons of measured electron contamination at maximum depth and estimated values with TG-51 formulae are presented in table I. All these values are referred to dose at 10 cm depth. 3

Electron contamination for 6 MV beams 5,5 4,5 Primus 6 MV SL18 6 MV SL 75 6 MV 3,5 Relative dose,5 1,5 0,5 0 0,5 1 1,5,5 3 3,5 4 4,5-0,5 Depth (cm) 5 FIG. 1. Electron contamination for 6MV Beams. Table I Comparison of measured electron contamination in the maximum and estimated values with TG-51. Machine Energy Modifier Position of maximum (cm) Electron contamination Electron contamination by TG-51 estimation Primus 6 MV None - open beam 1.6 0.7 0 SL75 6 MV None - open beam 1.4 0.8 0 SL18 6 MV None - open beam 1.5 0.8 0 SL18 15 MV None - open beam.8.3 0.6 SL18 15 MV Lead at 46. cm.9 1.0 0.8 SL18 15 MV Lead at 9. cm 3 1.9 1.7 Primus 18 MV None - open beam 3.1 1. 1.3 Primus 18 MV Lead at 50 cm 3. 0.9 1.0 Primus 18 MV Lead at 30 cm 3 1.9.1 According to TG-51, it is recommended that the lead foil be placed at 50 ± 5 cm. Variations in electron contamination due to positioning lead foil 45 cm to 55 cm from the water surface has been studied for the Primus 18 MV beam. The lead foil was placed at 45. cm, 49 cm, 50 cm and 51 cm. Variations are lesser than experimental uncertainty and can be seen in figure. Figure 3 indicates that electron contamination was higher for the lead foil place placed at 30 cm than for open geometry of the latter beam. 4

Variation of electron contamination because lead foil position (Primus 18 MV) 6 5 Lead at 45. cm Lead at 49 cm 4 Lead at 50 cm Lead at 51 cm Relative dose 3 1 0 0 1 3 4 5 6 7 8-1 Depth (cm) FIG..Variation of electron contamination because lead foil position. Electron contamination in 18 MV Primus 9 8 7 6 Lead at 30 cm Open field Lead at 50 cm 5 Relative dose 4 3 1 0 0 1 3 4 5 6 7 8-1 Depth (cm) FIG.3.Variation of electron contamination because lead foil position. Beam hardening effect is also considered, but comparison of measurements with and with or without lead foil; show that no beam hardening effect is measured beyond experimental uncertainty. 3. Quality indices and stopping power ratios (S w,air ) In table II the quality indices measured for the three low energy beams can be seen. Uncertainty has also been estimated. In the low energy measurements, only experimental uncertainty is considered. 5

Table II Quality indices measured for several low energy beams. Machine / Energy Method Quality index u Sw,air u AB u A u B kq NE571 Primus 6MV TRS-398 IC10 TPR 0,10 0.6738 0.0013 1.1198 0.0010 0.000 0.0010 0.993 TG-51 open beam %dd(10) 66.98 0.0 1.103 0.001 0.0005 0.0011 0.994 TG-51 + purging %dd x (10) 67.9 0.5 1.1195 0.001 0.0006 0.0011 0.993 SL18 6MV TRS-398 TPR 0,10 0.68 0.0011 1.118 0.0010 0.000 0.0010 0.993 TG-51 open beam %dd(10) 67.5 0.4 1.1197 0.001 0.0006 0.0011 0.993 TG-51 + purging %dd x (10) 67.57 0.18 1.1189 0.001 0.0004 0.0011 0.993 SL75 6MV TRS-398 TPR 0,10 0.6767 0.001 1.1193 0.0010 0.000 0.0010 0.993 TG-51 open beam %dd(10) 67.5 0.7 1.1197 0.0013 0.0006 0.0011 0.993 TG-51 + purging %dd x (10) 67.61 0.1 1.1188 0.0011 0.0003 0.0011 0.993 The results of beam quality index for high energy beams are shown in table III. In this table, uncertainty for %dd(10) x considered experimental uncertainties and type B uncertainties where available. Table III Quality indices measured for several low energy beams Machine / Energy Method Quality index u Sw,air u AB u A u B NE571 kq Primus 18MV TRS-398 IC10 TPR 0,10 0.7704 0.0013 1.0919 0.0011 0.0005 0.0009 0.978 TG-51 open beam 4 %dd(10) x 78.79 0.14 1.0930 0.00 0.0003 0.00 0.976 TG-51 lead at 45. cm %dd(10) x 78.73 0.36 1.0931 0.0014 0.0007 0.001 0.976 TG-51 lead at 45. cm + %dd(10) x 78.6 0.1 1.0934 0.001 0.0005 0.0011 0.976 TG-51 lead at 49 cm %dd(10) x 78.38 0.3 1.0939 0.0013 0.0005 0.001 0.976 TG-51 lead at 49 cm + %dd(10) x 79.03 0. 1.094 0.001 0.0005 0.0011 0.975 TG-51 lead at 50 cm %dd(10) x 78.91 0.3 1.097 0.0013 0.0005 0.001 0.975 TG-51 lead at 50 cm + %dd(10) x 78.83 0.19 1.099 0.001 0.0004 0.0011 0.975 TG-51 lead at 51 cm %dd(10) x 78.66 0.33 1.0933 0.0013 0.0005 0.001 0.976 TG-51 lead at 51 cm + %dd(10) x 78.38 0.0 1.0940 0.001 0.0005 0.0011 0.976 TG-51 lead at 30 cm %dd(10) x 79.13 0.9 1.09 0.0013 0.0004 0.001 0.975 TG-51 + purging %dd(10) x 78.8 0.18 1.099 0.001 0.0004 0.0011 0.975 SL18 15MV TRS-398 TPR 0,10 0.7650 0.001 1.0940 0.0011 0.0005 0.0009 0.980 TG-51 open beam 4 %dd(10) x 76.64 0.10 1.0980 0.00 0.000 0.00 0.979 TG-51 lead at 46. cm %dd(10) x 77.38 0.45 1.0963 0.0015 0.0009 0.001 0.978 TG-51 lead at 46. cm + %dd(10) x 77.5 0.09 1.0959 0.0011 0.000 0.0011 0.978 TG-51 lead at 9. cm %dd(10) x 77.48 0.31 1.0960 0.0013 0.0005 0.001 0.978 TG-51 + purging %dd(10) x 77.64 0.08 1.0957 0.0011 0.000 0.0011 0.977 The uncertainty of S w,air was divided into two independent uncertainties: those associated with experimental uncertainty (u A ) of quality indices, and uncertainties (u B ) caused by stopping-power-ratio fitting as a function of beam-quality index and %dd(10) x calculations from %dd(10) pb. 6

In SL-18 15 MV significant differences were found, especially for open beam measurements. In open beam, TG-51 underestimates electron contamination, so this difference could be explained by this result. 4. Discussion Theoretical comparison made by Huq et al [1] shows that the quotient of beam quality factors, k Q, from both protocols is between 1.000 ± 0.001, except for 75% < %dd(10) x < 85% or 0.70 < TPR 0,10 < 0.77, where lower values were found, although the k Q values agree within 0.% for almost the entire range of photon beam qualities used in hospitals. The greatest difference in calculated k Q from our measurements was found for SL-18 15 MV beam: 0.3% (for purging measurements), but for stopping power ratios, the biggest difference was 0.4%, for open beam (for purging measurements the difference is only 0.15%). Electron contamination is underestimated in TG-51 for this open beam but this fact tends to compensate the expected difference. Theoretical maximum difference was found for TPR 0,10 = 0.75 (measured beam: TPR 0,10 = 0.765), similar to beam quality index of measured 15 MV beam. Expected difference for this beam is.3%, which is the difference value obtained for measurements with, but measurements in open beam, with underestimated electron contaminations, differs only 0.1%. Landoni et al [] found similar results comparing TRS- 398 and TG-51. In a Clinac 100CD 15 MV beam (%dd(10) x = 77.7; TPR 0,10 = 0.756) difference for both protocols was 0.4% for a PTW 3000 chamber. Several measurements of experimental k Q values have been measured in the last few years [3][4][5]. These values are comparable to data from table II for both protocols for the three 6 MV beams. TPR 0,10 for SL-18 15 MV beam is 0.765, so the expected value of k Q from table II referred to above reference is 0.974 ± 0.010. The closest value to experimental data is k Q obtained with %dd(10) x measured with purging, although its calculated value of S w,air is closer to calculated values from TPR 0,10 than other %dd(10) x measured. For Primus 18 MV beam, the best agreement between k Q calculated from our measurements and experimental values is again obtained for measurements of %dd(10) x measured with the purging. Experimental values are 0.973-0.97 and are similar to calculated values: 0.975 0.978 (Tables II and III). The greatest difference between calculated %dd(10) x from %dd(10) Pb and direct measured %dd(10) x is for SL-18 15 MV beam and it was 1% (see table III). This difference is higher than expected for fit uncertainty [17]: maximum of 0.5%. Although this difference is so high, differences in S w,air were kept below 0.06%, lower than uncertainty associated to S w,air linear fit. Measurements in open beam are quite different. For the same beam, the difference S w,air (TPR 0,10 ) and S w,air (%dd(10) x ) from open beam measurement was +0.%. Anyway, with regard to this energy, the theoretical difference [1] is -0.3%, differences in k Q cannot be appreciated and, surprisingly, differences are lower in this case. Also, it must be noted that electron contamination is not always reduced by placing a lead foil. Figure 3 shows that electron contamination is higher when the lead foil is positioned at 30 cm from the water surface, but differences between %dd(10) x from %dd(10) Pb and directly measured %dd(10) x are of the same order as uncertainty. 5. Conclusions A purging was designed based on a permanent of Nd-Fe-B and removed all electrons produced in the treatment head. Electron contamination from the treatment head has been measured for a squared field of 10 x 10 cm and SSD = 100 cm. It can be seen that electron contamination is very machine dependent, and not only dependent on beam energy. More detailed results can be seen in the reference [6]. 7

Pure photon beam depth dose profiles were used to measure %dd(10) x directly, using the purging, and these values were compared with TG-51 calculated values from measurements in filtered and open beams. Associated-to-fit uncertainties to calculate beam quality index in TG-51 were reviewed and compare with TRS-398 uncertainties. Similar uncertainties were found in both protocols. For comparing protocols, two parameters were used: S w,air and k Q. Calculated k Q was compared with recent experimental k Q. For measurements at low energies, differences are lower than uncertainty and the deviation in experimental data offered by several authors is much higher. For high energy, closest agreement with experimental data was found using %dd(10) x, although electron contamination was not always correctly estimated (lead at 30 cm for 18 MV beam, and open beam for 15 MV). Nonetheless, the greatest discrepancy observed between both protocols is 0.3%[1]. 6. References [1] Almond P R, Biggs P J, Coursey B M, HansonWF, HuqMS, Nath R and Rogers DW AAPM s TG- 51 protocol for clinical reference dosimetry of high-energy photon and electron beams Med. Phys.1999 6 1847 70. [] Andreo P, Burns D T, Hohlfeld K, Huq M S, Kanai T, Laitano F, Smith V G and Vynckier S 000 Absorbed dose determination in external beam radiotherapy: an international Code of Practice for dosimetry based on standards of absorbed dose to water IAEA Technical Report Series No 398 (Vienna: International Atomic Energy Agency). [3] Schulz R J, Almond P R, Cunningham J R, Holt J G, Loevinger R, Suntharalingam N, Wright K A, Nath R and Lempert G D 1983 Task Group 1: a protocol for the determination of absorbed dose from high-energy photon and electron beams Med. Phys. 10 741 71. [4] Almond P R, Andreo P, Mattson O, Nahum A E and Roos M 1997 The use of plane-parallel ionization chambers in high-energy electron and photon beams. An international Code of Practice for dosimetry IAEA Technical Reports Series 381 (Vienna: International Atomic Energy Agency). [5] Andreo P, Cunningham J C, Hohlfeld K and Svensson H Absorbed dose determination in photon and electron beams. An international Code of Practice IAEA Technical Report Series No 77 (Vienna: International Atomic Energy Agency 1987). [6] Hohlfeld K The standard DIN 6800: Procedures for absorbed dose determination in radiology by the ionization method (IAEA-SM-98/31) Dosimetry in Radiotherapy vol 1 (Vienna: IAEA) pp 13- (1988). [7] Andreo P Absorbed dose beam quality factors for the dosimetry of high-energy photon beams Phys. Med. Biol. 37 189-11 (199). [8] Rogers D W The advantages of absorbed- dose calibration factors. Med. Phys. 19 17-39 (199). [9] Li X A, Rogers D W Reducing electron contamination for photon beam-quality specification. Med. Phys.. 6 791-7 (1994). [10] Kosunen A and Rogers D W O Beam quality specification for photon beam dosimetry. Med. Phys. 0 1181-8 (1993). [11] Andreo P On the beam quality specification of high-energy photons for radiotherapy dosimetry. Med. Phys. 7 434-40 (000). [1] Andreo P Reply to Comment on the beam quality specification of high-energy photons for radiotherapy dosimetry Med. Phys. 7 1693-5 (000). 8

[13] Sjogren R, Karlsson M Electron contamination in clinical high energy photon beams. Med. Phys.. 3 1873-81 (1996). [14] Biggs P J, Russell M D An investigation into the presence of secondary electrons in megavoltage photon beams. Phys Med Biol. 8 1033-43 (1983). [15] Ling C C, Schell M C, Rustgi S N Magnetic analysis of the radiation components of a 10 MV photon beam. Med. Phys. 9 0-6 (198). [16] Biggs P J, Ling C C Electrons as the cause of the observed dmax shift with field size in high energy photon beams. Med. Phys. 6 91-5 (1979). [17] Rogers D W. Correcting for electron contamination at dose maximum in photon beams. Med. Phys.. 6 533-7 (1993). [18] Rogers DW, Yang CL Corrected relationship between %dd(10)x and stopping-power ratios. Med. Phys. 6 538-40 (1999). [19] Brahme A, Andreo P Dosimetry and quality specification of high energy photon beams. Acta Radiol Oncol. 5 (3):13-3. (1986). [0] Andreo P Improved calculations of stopping-power ratios and their correlation with quality of therapeutic photon beams Measurement Assurance in Dosimetry: Proc. Symp. (Vienna, 1993) (Vienna: IAEA) pp 335 59. [1] Huq MS, Andreo P and Song H Comparison of the IAEA TRS-398 and AAPM TG-51 absorbed dose to water protocols in the dosimetry of high-energy photon and electron beams Phys. Med. Biol. 46 985-3006 (001). [] Landoni V, Malatesta T, Capparella R, Fragomeni R, Proietti A, Begnozzi L Comparison of the IAEA TRS-398 Code of Practice and the AAPM TG51 Protocol for Dosimetry Calibration of high energy photon and electron beam Physica Medica XIX 31-35 (003). [3] Guerra A S, Laitano R F and Pimpinella Experimental determination of the beam quality dependence factors, k Q, for ionization chambers used in photon and electron dosimetry Phys. Med. Biol. 40 1177-90 (1995). [4] Palmans H, Mondalaers W and Thierens H Absorbed dose beam quality correction factors k Q for the NE571 chamber in a 5 MV and a 10 MV photon beam Phys. Med. Biol. 44 647-63 (1999). [5] Short K R, Ross C K, Schneider M, Hohfeld K, Roos M and Peroche A M A comparison of absorbed dose standards for high-energy x-rays Phys. Med. Biol. 38 1937-55 (1993). [6] Lopez Medina A., Teijeiro A., Salvador A., Medal D., Vazquez J., Salgado M., Carrion M.Comparison between TG-51 and TRS-398: electron contamination effect on photon beam-quality specification Phys. Med. Biol. 49 (004) 1 16. 9